Rapid Fire Abstract session: usefulness of CT and radionuclide imaging in different clinical scenarios

Purpose: The National Institute for Health and Care Excellence (NICE) and the European Society of Cardiology (ESC) support the use of different cardiac imaging modalities in patients with suspected ischaemic heart disease (IHD). The cost of single photon emission computed tomography (SPECT) and invasive coronary angiography (ICA) in UK is estimated at £293 and £1052 respectively. Following positive SPECT, a large number of patients at our institution progressed to ICA which did not confirm significant coronary artery disease. As a result, a new SPECT scanner was acquired with ECG gating and in-built CT to correct for diaphragm / breast attenuation. Methods: We calculated cumulative cost of SPECT +/- ICA per patient before and after the scanner change. We screened patients with fixed / no defects on SPECT for acute coronary syndromes and cardiac related deaths in one year after the scan. Results: See Table 1. The new scanner detected significantly more fixed perfusion defects (p=0.0007, Fisher's exact test) and less reversible defects necessitating progression to ICA (p=0.001, Chi-square test). The cost of SPECT +/- ICA per patient was £713.8 in the old scanner group (£57,104 in total) and £468.3 in the new scanner group (£44,460 in total). Patients with normal SPECT or fixed defects did not have cardiac related deaths or acute coronary syndromes during following 12 months. Conclusions: The new scanner allowed for significant cost savings in our institution reducing the cost of SPECT +/- ICA from £713.8 to £468.3 per patient without compromising patients' safety. This is crucial in current climate of financial austerity. Our study was limited by the small number of patients and by the fact that many patients with reversible ischaemia were not referred for ICA due to different reasons: minor symptoms / ischaemia on SPECT (n=15), patients not attending follow up (n=3), non cardiac death (n=1), other imaging modalities chosen (n=2). <tbl id="jev253tbl1" loc="display"><tblbdy top-stubs="1"><r><c cspan="1" rspan="1"></c><c cspan="1" rspan="1">Old Scanner</c><c cspan="1" rspan="1">New Scanner</c></r><r><c cspan="1" rspan="1">Number of SPECT</c><c cspan="1" rspan="1">80</c><c cspan="1" rspan="1">96</c></r><r><c cspan="1" rspan="1">Reversible defect on SPECT</c><c cspan="1" rspan="1">42 (52.5%)</c><c cspan="1" rspan="1">27 (28.1%)</c></r><r><c cspan="1" rspan="1">Fixed defect on SPECT</c><c cspan="1" rspan="1">3 (3.75%)</c><c cspan="1" rspan="1">20 (20.8%)</c></r><r><c cspan="1" rspan="1">Number of ICA</c><c cspan="1" rspan="1">32 (40%)</c><c cspan="1" rspan="1">16 (16.7%)</c></r><r><c cspan="1" rspan="1">Cost of SPECT +/- ICA per patient</c><c cspan="1" rspan="1">£713.8</c><c cspan="1" rspan="1">£468.3</c></r></tblbdy><tblfn id="tblfn1"> SPECT/ICA results </tblfn></tbl>